Vaccination Barriers Research Articles

Mpox Vaccine Hesitancy Among Brazilian Men Who Have Sex with Men: A National Cross-Sectional Study

Background: Mpox is a viral zoonosis that has gained increased attention due to a global outbreak in 2022, significantly impacting men who have sex with men (MSM). Vaccination for this disease poses a public health challenge; because it carries a strong stigma, there may be greater hesitancy in vulnerable groups. Objectives: This study aimed to determine the prevalence and factors associated with Mpox vaccine hesitancy among Brazilian MSM. Methods: A cross-sectional study was conducted between September and December 2022 using an online survey targeted at MSM. Recruitment was carried out through social media and dating apps. The sample consisted of 1449 participants and the analysis involved bivariate logistic regression. Results: The prevalence of Mpox vaccine hesitancy was 7.57%. The significant factors associated with hesitancy were primarily related to sexual practices and attitudes towards Mpox exposure and diagnosis, such as not using “glory holes” (aOR: 19.82; 95% CI: 1.60–245.69), reluctance to undergo pre- and post-exposure testing for Mpox (aOR: 9.54; 95% CI: 5.52–16.48), and not knowing close contacts diagnosed with Mpox (aOR: 4.09; 95% CI: 1.72–9.73). Participants who would not take precautions after diagnosis (aOR: 3.00; 95% CI: 1.27–7.07) and those who would not disclose their serological status (aOR: 1.93; 95% CI: 1.13–3.30) also showed a higher likelihood of vaccine hesitancy. Conclusion: Public health strategies should address these factors to expand knowledge about vaccination barriers, plan educational campaigns with targeted messaging for the MSM population, and provide inclusive healthcare environments to increase vaccine acceptance and reduce Mpox transmission in vulnerable groups.

Self-Reported COVID-19 Vaccine Status and Barriers for Pediatric Emergency Patients and Caregivers

Objective: This study determined if the caregivers of children in the emergency department (ED) have the same COVID-19 vaccination status as the child, the reasons they chose to not vaccinate the child, and self-identified barriers to vaccination to determine if the ED is appropriate for vaccination intervention. Methods: A survey was administered to caregivers of pediatric ED patients at four Children’s Hospitals in: Augusta, GA, Buffalo, NY, Madison, WI, and Sacramento, CA. Participants were asked about their and the child’s demographics, vaccination status, and barriers to vaccination. We used descriptive statistics, Cohen's kappa, and logistic regression to analyze responses. Results: 941 caregivers were considered for enrollment, and 800 consented to participation. Participants were 75% women with a mean age of 40.9 ± 8.9 years. 51% (409) of the pediatric ED patients were COVID-19 vaccinated, as were 74% (591) of the caregivers. There was variation across sites, but overall, 15% of caregivers of unvaccinated children wanted the child tobe vaccinated with the most common barriers to vaccination identified as safety data (25%), time availability (20%), and ability to obtain an appointment (13%). The most common reason for not wanting the child COVID-19 vaccinated was concern the vaccine didn’t work or had too many side effects. Conclusion: A small but clinically important group of pediatric ED patients are not COVID-19 vaccinated but their caregivers want them to be vaccinated, indicating that consideration should be given to offering vaccination in the ED. Reasons for avoiding COVID-19 vaccination were primarily concerns with efficacy and side effects.

Developing a structured framework to address vaccination barriers for Newly Arrived Migrants in EU/EEA

Abstract Background Access to vaccination is a critical aspect of public health, particularly for newly arrived migrants (NAMs) in European Union/European Economic Area (EU/EEA) countries. Despite this, significant barriers exist, necessitating urgent attention. This study addresses the pressing need to improve vaccination coverage for NAMs by developing a General Conceptual Framework (GCF) to understand and overcome system barriers and analyzing possible strategies. Methods starting from a theoretical conceptualization, the study employed a mixed-method approach, incorporating literature review and qualitative research. The GCF was formulated based on key components of the vaccination process. Barriers and solutions were identified through a non-systematic literature review and qualitative investigation. The GCF served as a guide for study activities, facilitating data integration. Results The study outlines a structured GCF comprising five interconnected steps in the vaccination process: entitlement, reachability, adherence, achievement, and evaluation of vaccination. Barriers and solutions identified through literature review and qualitative research are presented. Strategies to enhance professional knowledge, accessibility, adherence, coverage, and intervention evaluation are proposed. Recommendations include proximity strategies, provider training, migrant-sensitive approaches, and robust data collection. Conclusions Equitable access to vaccination is paramount for public health, particularly for vulnerable populations like NAMs in EU/EEA countries. The development of the GCF represents a crucial step towards understanding and addressing barriers to vaccination access. Implementation of recommended strategies can significantly improve vaccination outcomes for NAMs, ultimately contributing to the overall health and well-being of these communities.

Empowering Professionals For Health to promote Newly Arrived Migrant vaccination uptake

Abstract Issue/Problem The imperative task of making access to vaccinations equitable and guaranteed for Newly Arrived Migrants (NAM) in Europe not only highlights a public health challenge but also offers a chance to tackle barriers within health systems. NAMs frequently encounter hurdles in accessing healthcare services, with vaccinations often ranking lower on their list of health priorities. The AcToVax4NAM project developed and implemented tailored interventions for Professionals FOR Health (PFH) working with NAMs in 8 EU countries. Description of the problem NAM often overlook vaccinations due to more immediate concerns, and health systems lack a comprehensive approach to vaccinations. Thus, piloted interventions were developed in consortium countries, working with PFH to tackle vaccination barriers. Over 3 months, each country implemented context-specific interventions to enhance health systems’ responsiveness using culturally appropriate tools. Key objectives included developing procedures, improving PFH cultural sensitivity communication skills, and assessing NAM vaccination intentions. Results Initial findings vary depending on the country’s context but generally show notable enhancements in PFH cultural competencies and increased willingness among NAM to get vaccinated. The pilots underscored the importance of tailoring strategies to specific contexts and fostering collaboration among stakeholders for a successful intervention. Lessons The results highlight the pivotal role of tailored interventions in addressing vaccination disparities among NAM. As PFH working with diverse populations, their role in implementing similar training programs in other settings facing similar challenges is invaluable to achieving equitable vaccination processes. Recommendations encompassing the lessons learned and challenges encountered throughout the pilot implementation will further facilitate the dissemination of this knowledge amongst relevant stakeholders.

Paving the way for equitable and guaranteed access to vaccination for Newly Arrived Migrants

Abstract Background There is a gap in knowledge on the country-specific access to vaccination for Newly Arrived Migrants (NAM) in Europe, the obstacles encountered, and the resources available to surmount these barriers. The AcToVax4NAM project addresses gaps in the vaccination process of NAM in 8 European countries by developing country-specific, action-oriented flowcharts of the vaccination pathway that identify barriers and provide barrier-specific solutions. The flowcharts are linked to a comprehensive Repository of Tools aimed at providing tools to overcome system barriers and ensuring equitable immunization access for NAM in all consortium countries. Methods Country-specific action-oriented flowcharts group the vaccination pathway for NAM in the five hubs (entitlement, reachability, adherence, achievement, and evaluation) and offer solutions for identified barriers. Participatory research validated these flowcharts via focus group discussions with 84 total professionals FOR health (PFH) involved in NAM immunization. The tools were sourced from all consortium countries, encompass diverse formats and languages, and provide a holistic approach to vaccination promotion. Results The validated instrument was deemed useful, relevant, and easily understandable. Validated barriers included the lack of multi-stakeholder collaboration, culturally competent PFH, tailored educational materials, and language barriers. Meanwhile, the linked Repository includes 359 tools categorized according to the five hubs of the vaccination pathway. These can be filtered by language, country, type of tool, year of issuance, and/or intended target population. Conclusions The flowcharts and the Repository serve as the basis for a pilot intervention aiming to strengthen healthcare system responsiveness to promote NAM immunization. This participatory approach aims to equip PFH with a clear understanding of system-level vaccination barriers and solutions to enhance vaccination uptake among NAMs.

Adherence to COVID-19 vaccination recommendations and vaccine hesitancy in US blood donors.

General vaccination rates have been falling globally despite unequivocal health benefits. Noncompliance can result from access barriers and/or hesitant attitudes. Few studies have investigated the prevalence and determinants of noncompliance with COVID-19 vaccination in blood donors. We surveyed blood donors on COVID-19 infection and vaccination history, barriers and motivations for COVID-19 vaccination, and comorbidities. We estimate the prevalence of noncompliance, the prevalence of hesitancy toward COVID-19 vaccines, and investigate associated factors using multivariable models. From December 2021 to December 2022, 33,610 survey respondents were included. Of these, 24% had not been vaccinated for COVID-19 or had missing vaccination information, and 99% of those who reported reasons for being unvaccinated declared at least one of three hesitant attitudes presented in the survey (safety concerns; personal/cultural/religious beliefs; being young and not worrying about being vaccinated). Among noncompliant donors, <2% reported access barriers. In the multivariable model addressing factors associated with vaccine noncompliance, younger age, male gender, White/Caucasian race, absence of comorbidities, residency in a State with less restrictive COVID-19 policies, and living in micropolitan or rural areas were identified as significant predictors. Younger age and White/Caucasian race were independently associated with vaccine hesitancy among noncompliant donors. We found high rates of noncompliance with COVID-19 vaccination in blood donors, mostly driven by vaccine hesitancy. Understanding vaccine adherence among blood donors-a relatively highly educated and healthy population, with good healthcare access and usually motivated by altruism-could provide key information on determinants of vaccine noncompliance that may be harder to overcome.

Key informant perspectives on overcoming HPV vaccination barriers in low-immunization NY counties

ABSTRACT Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13–15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent–doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

A guide to global access to HPV vaccination to all women in low- and middle-income countries; a minireview of innovation and equity.

Cervical cancer is caused by the human papillomavirus (HV), and accounts for more than 311,000 preventable deaths annually, with 85% occurring in low-and middle-income countries. Despite being preventable through screening and screening, significant barriers to implementing HPV vaccination persist in developing nations. This review study aims to identify these barriers and propose innovative, evidence-based solutions to improve vaccination rates and reduce cervical cancer mortality. A systematic review search was conducted using PubMed, Embase, and Cochrane Database of Systemic Reviews. Keywords related to HPV vaccination barriers and implementation strategies in developing countries were used. Relevant demonstration projects, pilot studies, and evidence-based research articles were reviewed. Identifiable barriers to a successful vaccine implementation program in a developing country include vaccine costs, societal, cultural resistance, misinformation, logistical challenges in vaccine delivery, and inadequate human resources. Solutions to these barriers include a subsidized vaccine pricing, community sensitization, education and well-trained media professionals to dispel misinformation, and partnerships with both public and private sector for efficient vaccine distribution. These findings highlight critical barriers that impede HPV vaccination efforts in developing countries and offers practical solutions to overcome these challenges. This aggregate of data can help inform future developing countries' implementation programs to further the World Health Assembly mission to vaccinate 90% of eligible girls globally by 2030.

Using Behavior Integration to Identify Barriers and Motivators for COVID-19 Vaccination and Build a Vaccine Demand and Confidence Strategy in Southeastern Europe

Introduction. The COVID-19 pandemic has significantly impacted global health, with Eastern Europe experiencing notable excess morbidity and mortality and vaccine hesitancy. This study utilized the Behavior Integration (BI) framework to identify barriers and motivators for COVID-19 vaccination and develop strategies to increase vaccine demand and confidence in Moldova, North Macedonia, and Serbia. Methods. A mixed-methods approach was employed, including qualitative interviews and quantitative surveys. The BI framework was used to integrate human behaviors with technical and operational considerations throughout the project. Results. A total of 2742 online surveys were collected in Moldova and Serbia, revealing significant barriers such as vaccine safety concerns (OR = 1.839, 95% CI: 1.328–2.547 in urban Moldova; OR = 1.990, 95% CI: 1.351–2.931 in urban Serbia), logistical challenges, and lack of institutional trust. Conversely, motivators included personal health concerns, recommendations from health care providers, and the desire to travel. The proposed social and behavior change strategy included a continuing medical education course that trained 2403 medical providers, with post-test results showing a 99% improvement in knowledge and confidence in applying the information, and collective engagement workshops for 3260 chronic disease patients and 842 pregnant women, of which 7% were vaccinated against COVID-19. Conclusions. The BI approach effectively identified and addressed vaccination barriers and motivators, leading to tailored strategies that increased vaccine uptake. Continuous stakeholder engagement, adaptive learning processes, and local organizations are crucial for refining program implementation, ensuring sustainability, and promoting public health.

Moral values and vaccination behavior in Russia during the COVID-19 pandemic

ObjectiveEffective persuasive communication necessitates message matching; the conveyed message should resonate with the recipient's characteristics, including individual moral values. While studies examining the relationship between moral values and vaccination behavior have been conducted in a limited number of countries, this study seeks to provide evidence on this relationship beyond Western democracies. MethodsA cross-sectional online survey was conducted from November 4 to December 17, 2021, in Russia. Participants reported their COVID-19 vaccination behavior and completed the Moral Foundations Questionnaire, designed to measure the endorsement of moral values (n = 415). Regression analysis was employed to assess the association between each moral foundation and COVID-19 vaccination behavior. ResultsOur findings indicate that the moral foundations of Care, Loyalty, Fairness, and Sanctity significantly influence vaccination behavior. Individuals who strongly endorse Fairness (AME = −0.019; 95 % CI = −0.033, −0.005) and Sanctity (AME = −0.016; 95 % CI = −0.031, −0.002) were less likely to be vaccinated. Conversely, individuals endorsing Care (AME = −0.018; 95 % CI = −0.031, −0.005) and Loyalty (AME = −0.015; 95 % CI = −0.028, −0.001) were less likely to report refusal of vaccination. These results remain robust after adjusting for sociodemographic variables related to vaccination barriers. ConclusionOur findings carry public health implications; an understanding of the moral psychology underlying vaccination behavior can facilitate more targeted and effective health communication. Employing skillfully crafted moral appeals may mitigate negative attitudes toward vaccination and enhance vaccination rates.

COVID-19 Vaccine Information Exposure: The Effect of Online Authority vs. Non-Authority Sources on Beliefs, Emotions and Information Engagement Behaviors.

Background/Objectives: Limited research has examined the theoretical linkages between exposure to COVID-19 vaccine information sources, vaccination-related beliefs, vaccination-induced emotions, and vaccine information engagement. Methods: An online survey was conducted with a national sample of adults (N = 630) residing in the U.S. to test these relationships, guided by the Stimulus-Organism-Response (S-O-R) framework and the Health Belief Model. Results: Study findings showed that exposure to online authority vaccine information sources was positively related to vaccination-benefit beliefs and negatively related to vaccination-barrier beliefs, in addition to hopeful feelings connected to vaccination. Exposure to non-authority sources was positively associated with vaccination-barrier beliefs, hopeful and fearful feelings connected to vaccination, and vaccine information engagement. While vaccination-benefit beliefs and vaccination-barrier beliefs were negatively and positively linked to vaccine information engagement, respectively, these beliefs were each positively connected to hopeful feelings and fearful feelings toward vaccination in that order. Both hopeful and fearful feelings toward vaccination also emerged as positive correlates of vaccine information engagement. Conclusions: This study contributes to our understanding of how cognitive appraisals of and affective responses to risk information disseminated by different types of sources may be related to risk information engagement behavior in a public health crisis. Results bring evidence-based insights to both researchers and health professionals to better equip them to counter vaccine misinformation and reduce vaccination barriers.

The role of personal health beliefs and altruistic beliefs in young Chinese adult men’s acceptance of the human papillomavirus vaccine

Administering the human papillomavirus (HPV) vaccine to men offers substantial health benefits for both themselves and their female partners. In mainland China, the HPV vaccine has not been approved for men, and little is known about their acceptance of it. This study aims to assess the acceptability of HPV vaccine among young Chinese adult men and examine the association between personal health beliefs, altruistic beliefs, and HPV vaccination intentions and behavioral attempts. A cross-sectional study was conducted among male university students using a multistage cluster sampling method in eight universities across five districts in Zhejiang Province, China. Data were collected from December 2020 to January 2021 using a self-administered, anonymous online questionnaire. Of the 1937 participants, 1009 who had heard of the HPV vaccine completed the questionnaire. Over one-third (40.4%, 408/1009) had high levels of HPV and HPV vaccine knowledge. A total of 695 of 1009 (68.9%) expressed an intention to receive the HPV vaccine when available, and 329 of 1009 (32.6%) had proactively inquired about male HPV vaccination. Perceived susceptibility, perceived benefits, perceived gender barriers, and perceived benefits of male HPV vaccination for female partner were associated with HPV vaccination intentions. Lower perceived vaccine barriers, greater perceived benefits, and stronger vaccination intentions were associated with higher HPV behavioral attempts. There is an emerging demand for HPV vaccinations among young adult men in mainland China. Personal health beliefs and altruistic beliefs are crucial in promoting young adult men’s acceptance of the HPV vaccine. Emphasizing both male-specific benefits and altruistic motivations may enhance HPV vaccine acceptability among young adult men.

Resilience throughout COVID-19: Unmasking the realities of COVID-19 and vaccination facilitators, barriers, and attitudes among Black Canadians.

Black communities have suffered disproportionately higher numbers of COVID-19 cases and deaths in Canada. Recognizing the significance of supporting targeted strategies with vulnerable populations extends beyond the COVID-19 pandemic, as it addresses longstanding health disparities and promotes equitable access to healthcare. The present study investigated 1) experiences with COVID-19, 2) COVID-19's impact, and 3) factors that have influenced COVID-19 vaccine acceptance and uptake among stakeholders and partners from the Federation of Black Canadians' (FBC). We conducted semi-structured interviews with 130 individuals and four focus groups with FBC, including stakeholders and partners, between November 2021 and June 2022. The semi-structured interviews and focus group discussions were conducted virtually over Zoom and lasted about 45 minutes each. Conversations from interviews and focus groups were transcribed and coded professionally using team-based methods. Themes were developed using an inductive-deductive approach and defined through consensus. The deductive approach was based on Consolidated Framework for Implementation Research (CFIR) domains and constructs. First, regarding experiences with COVID-19, 36 codes were identified and mapped onto 13 themes. Prominent themes included 39 participants who experienced highly severe COVID-19 infections, 25 who experienced stigma, and 18 who reported long recovery times. Second, COVID-19 elicited lifestyle changes, with 23 themes emerging from 62 codes. As many as 97 participants expressed feelings of isolation, while 63 reported restricted mobility. Finally, participants discussed determinants that influenced their vaccination decisions, in which 46 barriers and four facilitators were identified and mapped onto nine overarching themes. Themes around the CFIR domains Individuals, Inner Setting, and Outer Setting were most prominent concerning vaccine adoption. As for barriers associated with the constructs limited available resources and low motivation, 55 (41%) and 46 (34%) of participants, respectively, mentioned them most frequently. Other frequently mentioned barriers to COVID-19 vaccines fell under the construct policies & laws, e.g., vaccine mandates as a condition of employment. Overall, these findings provide a comprehensive and contextually rich understanding of pandemic experiences and impact, along with determinants that have influenced participants' vaccination decisions. Furthermore, the data revealed diverse experiences within Black communities, including severe infections, stigma, and vaccine-related challenges, highlighting the importance of targeted interventions, support, and consideration of social determinants of health in addressing these effects.

2024 Public Health Actions to Reduce the Burden of Asthma: Influenza and COVID-19 Vaccination Uptake Among People with Asthma.

This study sought to identify COVID-19 and influenza vaccination rates and barriers among people with asthma. The Asthma and Allergy Foundation of America (AAFA) conducted an online survey from April to May in 2022 among a convenience sample of 350 individuals with asthma. Most survey respondents reported that they had received an influenza vaccine for the 2021-2022 flu season (77%) and at least 1 dose of a COVID-19 vaccine (87%). Age, gender, race and ethnicity, and household income were significantly associated with influenza vaccination. Age and urban-rural classification were associated with COVID-19 vaccination. Access issues were not commonly reported as vaccination barriers, highlighting educational opportunities.

Knowledge of HPV vaccination and associated HNC and treatment decision-making among minority populations

ObjectiveUnderstand vaccination knowledge and barriers to vaccination among minority adults. Study designCross-sectional survey. SettingOtolaryngology clinics at a safety net hospital and a tertiary academic center and a head and neck cancer screening event. MethodsSurvey was administered to consenting patients. Descriptive statistics and significance testing were used to characterize the data, with non-minority respondents as controls. Multivariate logistic regression was used to understand factors associated with vaccination. ResultsHPV vaccination among our 241 respondents (n = 41, 17.67 %) and their qualifying children (n = 52, 33.55 %) was low. Non-vaccinated minorities were significantly more likely to express interest in HPV vaccination (28.66 % vs 8.66 %, p = 0.016). Minority patients were significantly less knowledgeable about HPV causing cervical (88.64 % vs 72.45 %, p = 0.024) and head and neck (68.18 % vs 44.90 %, p = 0.005) cancer and were also less aware of HPV infection (95.45 % vs 81.12 %, p = 0.020) among non-women. Lack of knowledge about the HPV vaccine was the most cited reason why minority patients did not or were uninterested in vaccination for themselves or their children. In a multivariable logistic regression of factors associated with HPV vaccination, only increased age demonstrated a significant association with vaccination likelihood (OR = 0.91, 95 % CI = [0.88–0.95], p < 0.001). ConclusionReported HPV vaccination rates were low for both white and minority patients but did not significantly vary on univariate or multivariate analysis. However, minority respondents were significantly less knowledgeable about HPV and its manifestations; they most often cited inadequate knowledge as why did not receive or were uninterested in HPV vaccination. As such, HPV vaccination educational interventions may raise vaccination rates among minority populations.

Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index.

County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine. This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups. Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versushigh/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05). Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

Stakeholder perspectives of immunisation delivery for adolescents with disability in specialist schools in Victoria, Australia: ‘we need a vaccination pathway’

BackgroundAdolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability.ObjectiveTo identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake.MethodsQualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF ‘Journey to Immunization’ model.Results32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program.ConclusionsOur study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake.

Exploring perspectives on vaccinations delivered in complementary nonclinical settings and by nonphysician health professionals: A qualitative interview study

BackgroundAlthough vaccines are an effective solution for preventing infectious disease, some vaccination rates remain below national targets, creating a need to increase vaccination access and uptake. A potential solution to improve vaccination rates is the implementation of policies that allow for more convenient vaccination access, such as the expansion of vaccination delivery by nonphysician healthcare providers (NPHPs) outside of traditional clinical settings. ObjectiveTo understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by NPHPs, and the barriers surrounding administration. MethodsWe performed interviews with healthcare providers and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. ResultsThirty-eight participants completed interviews. Participants reported that U.S. individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. ConclusionNPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the United States.

Interventions addressing routine childhood immunization and its behavioral and social drivers.

Despite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions. Experimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0-5 years or the intermediate outcomes were included from 3ie's review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie's Evidence Gap Map and the WHO's Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed. One hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.

Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia

ABSTRACT Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants’ immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.